Basic Information
| Provider Information | |||||||||
| NPI: | 1730156076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHIEN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1422 OLD WEISGARBER RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655584400 | ||||||||
| FaxNumber: | 8655584471 | ||||||||
| Practice Location | |||||||||
| Address1: | 1422 OLD WEISGARBER RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379092674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655584400 | ||||||||
| FaxNumber: | 8655584471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD21414 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 21414 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100010064 | 01 | TN | TENNCARE | OTHER | 200030088 | 01 | TN | RAILROAD MEDICARE | OTHER | TN0152 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 098041241 | 01 | TN | TRICARE | OTHER | 1196196 | 01 | TN | UNITED HEALTH CARE | OTHER | 3059706 | 05 | TN | MEDICAID | 4397728 | 01 | TN | AETNA | OTHER | 3071385 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | P00910368 | 01 | TN | RAILROAD MEDICARE | OTHER | TN0120 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER |